2019 -- S 0773 SUBSTITUTE A

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LC002138/SUB A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2019

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A N   A C T

RELATING TO HEALTH AND SAFETY - SEPSIS PROTOCOLS

     Introduced By: Senators Pearson, Lynch Prata, and McCaffrey

     Date Introduced: April 04, 2019

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 23-17 of the General Laws entitled "Licensing of Health-Care

Facilities" is hereby amended by adding thereto the following section:

     23-17-65. Protocols for the early recognition and treatment of patients with severe

sepsis/septic shock.

     (a) For purposes of this section, the following words and terms shall have the following

meanings:

     (1) "Sepsis" means a life-threatening organ dysfunction caused by a dysregulated host

response to infection.

     (2) "Septic shock" means sepsis with persisting hypotension and having a serum lactate

level >2 mmol/L despite adequate volume resuscitation.

     (b) On or before February 1, 2020, the director of health shall develop in coordination

with the Antimicrobal Stewardship and Environmental Cleaning task force, and make available to

health care practitioners, information on best practices for the treatment of patients with sepsis

and septic shock. The best practices shall be based on generally accepted standards of care,

including, but not limited to:

     (1) An evidence based screening tool that can be used at initial evaluation of adult and

pediatric patients in the emergency department;

      (2) An evidence based treatment protocol for adult and pediatric patients that includes

time-specific treatment goals;

     (3) Nurse-driven testing protocols to enable nurses to initiate care for patients with

suspected sepsis;

     (4) Incorporation of sepsis screening and treatment tools into the electronic health record

where possible;

     (5) Mechanisms to prompt escalation of care within the facility, and, when appropriate, to

stabilize and transfer to a facility able to provide a higher level of care;

     (6) Strategies for appropriate hand-offs and communication regarding the care of patients

with sepsis and for the reassessments of patients at regular intervals;

     (7) Hospital specific antibiotic guidelines for use in treating patients with sepsis and a

mechanism for reevaluating a patient’s antibiotic treatment based on culture results that provides

reassessment and de-escalation of antibiotic treatment when appropriate; and

     (8) Staff education on sepsis policies and procedures during the onboarding process and

at least annually or when new practice guidelines are published or existing standards are updated

to ensure that care reflects current standards of practice.

     (c) In order to enhance patient safety and protection, each hospital and freestanding

emergency-care facility licensed in the state shall implement policies and procedures in

accordance with the best practices issued by the department of health.

     (d) Beginning on February 1, 2021, the department of health shall not issue or renew a

license unless the applicant is in compliance with this section.

     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY - SEPSIS PROTOCOLS

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     This act would require hospital medical staff to adopt, implement, periodically update

and submit to the director of health, evidence-based protocols for the early recognition and

treatment of patients with sepsis and septic shock ("sepsis protocols" that are based on generally

accepted standards of care).

     This act would take effect upon passage.

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